There major depression with particularly severe symptoms can be treated with brain stimulation on request. This was declared by a group of experts fromUCSF Weill Institute for Neurosciences.
There Research in this regard it has been published in the scientific journal Nature Medicine.
Major Depression: What Is Brain Stimulation?
“This study points the way to a new paradigm that is desperately needed in psychiatry “, he has declared Andrew Krystal, Ph.D., professor of psychiatry and member of the UCSF Weill Institute for Neurosciences. “We developed a precision medicine approach that successfully managed treatment-resistant depression from a our patient by identifying and modulating the circuit in her brain that is uniquely associated with her symptoms ”.
Previous clinical trials have shown limited success in treating depression with traditional medicine deep brain stimulation (DBS), partly because most devices can only deliver constant electrical stimulation, usually only in one area of the brain. A major challenge for the industry is that depression can involve different areas of the brain in different people.
What made this proof of principle successful was the discovery of a neural biomarker, a specific pattern of brain activity that indicates the onset of symptoms, and the team’s ability to customize a new DBS device to respond only when it recognizes that pattern. The device then stimulates a different area of the brain circuit, creating immediate on-demand therapy that is unique to both the patient’s brain and the neural circuit causing her disease.
This personalized approach has almost alleviated symptoms of the depression greater of the patient, Krystal said, in contrast to the four to eight week delay of standard treatment patterns and it lasted beyond the 15 months she had the device implanted. For patients with treatment-resistant long-term depression, this finding could be transformative.
The path to this project at UCSF began with a major multi-center effort sponsored in 2014 by President Obama’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative.
Through this initiative, the UCSF neurosurgeon Edward Chang, MD, and colleagues conducted studies to understand depression and anxiety in patients undergoing surgical treatment for epilepsy, for whom mood disorders are also common. The research team discovered patterns of brain electrical activity related to mood states and identified new brain regions that could be stimulated to relieve depressed mood.
With previous research results as a guide, Chang, Krystal and the first author Katherine Scangos, MD, Ph.D., all members of the Weill Institute, developed a strategy based on two steps that had never been used in psychiatric research: mapping a patient’s depression circuit and characterizing her neural biomarkers.
“This new study brings together nearly all of the critical findings from our previous research into a comprehensive treatment aimed at alleviating depression“, he said Chang, who is senior co-author with Krystal and the Joan and Sanford Weill Chair of Neurological Surgery.
The team evaluated the new approach in June 2020 as part of an FDA experimental device exemption, when Chang implanted a reactive neurostimulation device that he successfully used in the treatment of epilepsy.
“We were able to provide this personalized treatment to a patient with depression and it alleviated his symptoms “, Scangos said. “We have not been able to do this type of personalized therapy previously in psychiatry ”.
To personalize the therapy, Chang placed one of the device’s electrode cables in the area of the brain where the team found the biomarker and the other cable in the region of a voluntary patient’s depression circuit, where stimulation best relieved her own. mood symptoms. The activity was constantly monitored; when it detected the biomarker, the device signaled the other lead to deliver a small dose (1 mA) of electricity for 6 seconds, which caused the change in neural activity.
“The effectiveness of this therapy demonstrated that not only did we identify the correct brain circuit and biomarker, but we were able to replicate it at a completely different later stage of the trial using the implanted device “, Scangos said. “This success in itself is an incredible advance in our understanding of the brain function that underlies mental illness. “
Despite the promising results: “There is still a lot of work to do “, said Scangos, who enrolled two more patients in the study and hopes to add nine more. “We need to observe how these circuits vary between patients and repeat this work over and over. And we need to see if an individual’s biomarker or brain circuitry changes over time as treatment continues. “
FDA approval for this treatment is still a long way off, but the study points to new avenues for treating depression greater. Krystal said that understanding the brain circuits underlying depression is likely to guide future non-invasive treatments that can modulate those circuits.
Scangos concluded: “The idea that we can treat symptoms as they arise is a whole new way of dealing with the most difficult to treat cases of depression. “